001519 (SFD)Building 7946(), � UlWiM
Address
Owner ry�y�
Gil �C�' . f"r"'xp-
Mailing. '
Address BOO! E&*M St. 2700 _.
City Zip Tel.
P.O. BOX 1504 NO..
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253.
8=1011111n 1 968 IL -800-367-5054,
Contractor
_TT
_ Address.
P.O. 173
City . _ Zip .. Tel."
001-59
BUILDING:- TYPE CONST. • V 174 OCC: GRP., .' - R 3
A.P. Number
Legal Description
- W
Project Description
�.. .. 146 its ReEd4mit4a Dmmlr
State Lic.City
1247
& Classif.: 44Lic.
2P122..
# 237
Sq. Ft.'
Size. 3
No. No. Dw.
Stories Units --
Arch:, Engr., . .. .... --
..Designer
New,W Add ❑
Alter ❑ Repair ❑ Demolition ❑•
Address
Tel.
340 S. `l.- -
323—.7877s..-�..
City
Zip
State
Lic. # ..
LICENSED CONTRACTOR'S DECLARATION ..
hereby affirm that I am licensed under provisions of Chapter 9 (commencing witli Section
7000) of Division 3 of the Business and Professions Code; and my license is in full force and,
effect.
... .. .. ..
.. .. -.
,
. SIGNATURE '+...e+' / ..° t c: .• f / ... J DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business,and Professions Code: Any city o!. county.: which requires_ a
..reason:
to construct, alter, improve, .demolish, or repair any structure,prior. to Its issuance also
• requires the applicant for such permit to file a signed, statement that he is licensed pursuant to
the provisions of.the Contractor's License.Law, Chapter .9.(commencing with Section 7000) of
' Division' 3 of'the'Business and Professions Code, &} that. he is. ex'empt'theieffbm, and the basis_
for the alleged exemption. Any violation of Section' 7031.5 'by 'any applicant for, a permit
' subjects the applicant to a civil penalty of.not more than five hundred.dollars'($500):
' p. I, as owner of the property, or, my employees with wages as their sole. compensation; will
do the work, and the structure is not intended or offered for sale: (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an; owner of property -who
builds or improves thereon and who does such work himself or through his own employees,
.• provided. that' such improvements are not intended or offered for sale. If, however, the building
Estimated Valuation�qp��
aate�►
'- /.l a`74TfL�.8.II8S
PERMIT
,.
AMOUNT
Plan ,Chk. Dep. -
-- . .- 3.€ 5.72. .
Plan Ch k.' Bal.:
Elf ydd�
�v6.eGa!
Const.. -
"Mech. - -'
gay 0
'..></•.Ci
Electrical
or improvement is sold within one year of completion, the owner -builder will have the burden .
of proving that he did not build or improve for the purpose of sale.) - ..
Plumbing%���
❑ I, as owner of.the property, am exclusively contracting -with licensed contractors to con--
struct the project. (Sec. •7044, Business and Professions Code:- The Contractor's .License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
•• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O.Lam exempt under Sec. B. & P:C.-for this reason .
S•M;I•
Grading
Driveway Enc.
Date owner
Infrastructure
DaferrW its as acrraemnt.
f ft.tm. Din al. `k]§gmtrw.
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that I have a certificate of consent to 'self -insure, 'or a certificate of .
Worker's Compensation Insurance, or a certified.copy thereof. (Sec. 3800, Labor Code.) . .
' Policy No:Company
❑ Copy is filed.with the city.. O Certified copy is hereby furnished.
TOTAL
962 -GO !tea ap.
REMARKS
CERTIFICATE OF EXEMPTION FROM
,.WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for .one hundred dollars (3100) valuation
or less.) . .. ..
certify that in the performance of thg work for which this.permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation=
Laws of California.
- -
- - -
Date " "Owner
NOTICE TO APPLICANT: • If, after making " this - Certificate of Exemption you should become
' subject to the Workers' Compensation provisions of the Labor code;: 'you' must'fortnwith-
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: • _
. Minimum Setback Distances:.
Front Setback. from Center,Line
'
Rear Setback from, Rear Prop..Line
_. CONSTRUCTION LENDING AGENCY
Side Street Setback.from Center Line
I hereby affirm that there is a construction. lending -agency for.the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) ;
Side Setback from. Property. Line
Lender's Name
Lender's Address
This is a building permit when properly filled out;7signed and validated, and is'subject to':
expiration it work thereunder is suspended for 180 days:
FINAL DATE
INSPECTOR
I certify that I have read this application and state -that the above information is correct:
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter 'the -above-.'
mentioned property for inspect) n purposes. / $ r`
Signature of applicant�l +� 7f Date �• ` Y
Mailing Address f
Issued by:-.
}
Validated by;
Validation:
Date Permit
..
City, State, Zip `
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. p
CARP. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class Lfc: Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
'following reason (Sec. 7031.5• Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty o1 not more than five hundred dollars ($500.):
O I, as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's license
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
through his own employees• provided that such improvements are not intended or offered for sale. It, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
O 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does rat apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
-This permit becomes void it work not commenced within 180 days from date of issuance, OR. If work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERSTOMPENSATION INSURANCE: This section need not be completed if
ON: I hereby affirm that I am licensed under provisions of Chapter 9 the permit is for one hundred ($100) o, less. I certify fiat in the performance of the work for which this permit is
sion 3 of The Business and Professions Code, and my license is in full force Issued. I shall not employ any person In any manner so asto become subject to the Workers'Compensalion Laws of
California.
APPLICANT NAME (l, F, MI) i1i cbristxIaction
ADDRESS
P.O. Box 173
CITY/COMMUN ITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITYICOMMUNITY/STATEal P
La.Quinta, CA 92253
BOK
PAG
PRC
I C
TWN
RNG
SE
S
903
199 9
LD%
Elect- Fee 60.18
MOD
so
TRACT NAME
HORIZON PAIMS
OWNER NAME (L. F. MI) General Management Corp.
CONTRACTOR -FIRM NAME
J. L. Constniction
ADDRESS
aboim
CITY/COMMUNITY/STATE/ZIP .
PHONE .
105.72 DEP. PAID
LICNC •
ARC/ENG FIRM NAME
Michael Baccino Assoc.
ADDRESS
340 S. Farrell Dr.,A212
CITY/COMMUN ITY/STATE21 P
Palm Sorincrs, CA 92262
PHONE • LICNC •
323-7877
USE OF PERMIT '
Single Family Dwelling
BL
60
ZON,,
FSB
SSB
SSB
RSB
DEC.
ZONE ORD •
LOT SZ
END
SIDE
Date Applicant
'NOTICE TO APPLICANT: If, after making this Certilicate o1 Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you mus; forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 1 hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z Art 2. Sec 341. Title 8.
C.A.C.),
O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
'city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent `Date
Print Applicant/Agent Name 6 O 15
..
APPL/PRMTffO- ''"I -DATE
22-85
S.F.D.
•Pertni-t to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garage
as loer approved plans.
h. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect- Fee 60.18
SW Fee 5.46
.plimbing Fee 85.00
Infrac;tnicture
•862.60
105.72 DEP. PAID
756.88
*Tam&prred pa=ant as per 4gremtait
t Department
TOTAL
•
'FEE2
60
A i L 4 1 D L 88 CK
FINANCE VALUATION F77,948.00, ,